Healthcare Provider Details

I. General information

NPI: 1639941537
Provider Name (Legal Business Name): BUCKHORN TREATMENT CENTER AT SOUTH MOUNTAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 S 48TH ST
PHOENIX AZ
85044-5364
US

IV. Provider business mailing address

8006 S 38TH PL
PHOENIX AZ
85042-9621
US

V. Phone/Fax

Practice location:
  • Phone: 480-293-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOHNSON JR.
Title or Position: C.E.O.
Credential:
Phone: 480-293-4327